· web viewquarter 1 2017-18 . table of contents. south island work that supports the new zealand...

Quarter 1 2017-18

Table of ContentsSouth Island work that supports the New Zealand Health Strategy 3

Clinical Services 4

Southern Cancer Network 4

Child Health SLA 7

Mental Health and Addiction SLA 8

Health of Older People SLA 10

Palliative Care Workstream 12

Cardiac Services Workstream 13

Elective Services Workstream 16

Major Trauma Workstream 17

Public Health Partnership 18

Stroke Services Workstream 19

Key Enablers 21

Quality and Safety SLA 21

Information Services SLA 23

Workforce Development Hub 25

2

South Island Alliance work that supports the New Zealand Health Strategy

3

Value and high performance

Te whāinga hua me te tika o ngā mahi

One teamKotahi te tīma

Smart system

He atamai te whakaraupapa

Closer to home

Ka aro mai ki te kāinga

People-powered

Mā te iwi hei kawe

All New Zealanders Live wellStay wellGet well

The adoption of the South Island cancer MDM System (SIMMS) is now well underway across the region. The adoption commenced in July 2017, with Canterbury Gynae-oncology and lung MDMs going “live”.

The South Island Dementia Model of Care is now finalised and ready to be circulated widely across all providers.The South Island DHBs have agreed priorities to be addressed/implemented in the first two years. There is widespread support across the region for the Model of Care, as well as interest nationally.

Electronic Advance Care Plan format has been finalised for the Health Connect South system. Work has now moved to finalising the print version of the electronic form.

Analysis of data from ANZACS QI has helped SDHB identify that not all areas in the district have been gaining equitable access to PCI. Steps have been taken to make improvements, and future ANZACS QI reports will indicate if these have been successful in ensuring equitable access irrespective of location.

With launch of HealthOne in Nelson Marlborough on 1 August 2017, all five South Island DHBs are now sharing relevant patient information electronically. General practice teams can view a person’s test results and discharge summaries, and hospital physicians can access information about allergies, long-term conditions and current medications. Health professionals from around the South Island access HealthOne around 3000 time daily.

Progress in developing the cross-sectoral South Island Public Health SLA is continuing with a co-design workshop held in August drawing participants from a wide range of agencies and sectors. The focus of the day included the structure and developing a common agenda.

A South Island regional approach to nurse prescribing has been agreed, this is a new piece of work. A workplan has been developed which includes the development of a policy and framework for implementation across the sector.

KEY AREAS DELIVERABLES

Timeliness of services across the cancer pathway (FCT)

1 Support DHBs to deliver the extended FCT target of ‘At least 90% of patients receive their first treatment within 62 days of being referred with a high suspicion of cancer and a need to be seen within 2 weeks by July 2017’

Q1,2,3,4

2 Support DHBs with undertaking and delivering the FCT Round 2 Funded Projects

Q1,2,3,4

3 Undertake a focused review to understand the ‘Route to Service Access/Diagnosis’ for all South Island cancer patients, with a focus on first presentation through ED

Q2

4 Continue to support the maintenance or improvement of the 31 day Indicator: proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment within 31 days (85% target for PP30 31 day indicator)

Q1,2,3,4

5 Development of comparable timely, cancer pathways for the SI Q1,2,3,4

6 Undertake an annual assessment of the Cancer Clinical Priorities, through the South Island/SCN Cancer Clinical Leads Group

Q1

7 Supporting DHBs in preparation for the introduction of a national bowel screening programme - focus on services to support the delivery of additional cancer cases

Q1,2,3,4

8 Support DHBs with the implementation of the Early Lung Cancer Guidance (to be published shortly)

Q1,2,3,4

Service coordination and quality improvement

9 Multi-disciplinary meetings: Complete the rollout of the regionally agreed MDT recommendations and service improvement initiatives started in 2015-16

Q1,2,3,4

10 Multi-disciplinary meetings: Review South Island MDM System against national specification

Q1,2,3,4

11 Multi-disciplinary meetings: Focused work to support findings from MDT meeting review e.g. meeting etiquette, training - MDT Coordinators, Chairs, referral requirements/timelines for radiology/pathology review, MDM resourcing

Q1,2,3,4

12 Multi-disciplinary meetings: prioritisation of cases for discussion at MDMs

Q1,2,3,4

13 Survivorship: Rollout of (national) Supportive Care Framework across the South Island

Q1,2,3,4

14 Survivorship: TBA

15 Support implementation of the National Radiation Oncology Plan

Reducing inequalities

16 Improved collection of ethnicity data across the whole health spectrum

Q1,2

17 Support the rollout of the Maori Cancer Pathways Project across the South Island

Q1,2

18 Review and develop a plan to increase the uptake of cervical screening among Maori communities (Te Waipounamu Maori Leadership Group (TWMLG) Priority area)

Q1,2

19 Support the collaborative regional working of both TWMLG & the SI CCG and integrate as co-partners into the regional plan

Q1,2,3,4

20 Support the rollout and implementation of the Psychosocial and Supportive Care Initiative across the South Island, and assess early findings

Q1,2,3,4

South Island Cancer Intelligence Service

21 Develop a plan to support and implement the NZ Cancer health Information Strategy across the South Island

Q1,2,3,4

22 Produce and further develop a Quarterly Cancer Dashboard to understand progress against cancer standards and targets, and to identify areas for service improvement

Q2,4

23 Develop a regional strategic cancer plan to identify priorities out to 2025.

Q2,4

KEY PROGRESS IN QUARTER 1Timeliness of services across the cancer pathway (FCT)

1-6 The South Island Operational Leads Group continues to focus on Faster Cancer Treatment as their first priority. The SCN is supporting SI DHBs in delivery of the following MOH-funded FCT projects: Ongoing: Improving the Cancer Pathway for Maori (SI-wide, led by NMDHB) Ongoing: Diagnostics Fast Track Clinics (SDHB) Completed: Pathway Entry, Routes to Diagnosis, part A: Emergency

presentations (SDHB) Ongoing: Pathway Entry, Routes to Diagnosis, part B: all cancers (SI-wide, led

by SDHB) Completed: Melanoma, find the spot Ongoing: Gynaecology High Suspicion of Cancer Referral Pathway (CDHB) Ongoing: Valuing patient’s time in complex cancer: Head and Neck (NMDHB &

CDHB)

The majority of projects are on track, with no major issues having an impact on successful completion. The HSCan gynae project rollout is still delayed, however there has been recent progress and confirmation of a commitment to complete.

7 SCN is linked into the SI Clinical Leads Oversight Group to monitor impact of programme implementation on cancer volumes for DHBs as the programme rolls

4STATUS KEY: Not Started Critical Caution On target Complete

SOUTHERN CANCER NETWORK

out

Service coordination and quality improvement9-12 SCN is leading 3 separate projects within the ‘Supporting MDM’ portfolio:

1. The adoption of the South Island cancer MDM System (SIMMS), formerly known as the Southern DHB-developed cancer MDM system, is now well underway across the SI. The adoption commenced in July 2017, with Canterbury Gynae-oncology and lung MDMs going “live”. We are on track to have a total of five to six MDMs on the new system by December 2017, with the remaining MDMs on the system by June 2018.As MDMs are rolled out onto the new system support is being provided to ensure there is good governance and clinical leadership in place as well as timely review of terms of reference and supporting arrangements.

2. As part of this work SCN is also undertaking a “MDM Gap Analysis” as requested by the Ministry as part of the Cancer Health Information Strategy. This work will measure the “gap” between the current MDM state (SIMMS) and the Ministry’s MDM Future State Business Processes and Data items, including options to progress towards this. This work is time limited and will be completed by December 2017.

3. The findings from the MDM ‘quality’ review were released in early 2017 and the SCN is undertaking work with SI MDMs to implement the recommendations and actions identified as a result of the findings. Much of this will be incorporated in the SIMMS adoption as described above.

To further enhance the projects above, the SCN is supporting the MDT/M Coordinators that work closely with the clinical teams, coordinate the MDM and in many DHBs are also involved in the FCT tracking process. Considerable focus is being given to ensure “buy in” and a willingness from the MDM Coordinators to learn how to use the SIMMS and incorporate it into their workflow. There is a high level of anxiety around this for them as it will extend their current skill set to support documentation in the live MDM environment. SCN in close collaboration with Clinical leaders and managers are giving attention to ensure support and appropriate training is provided. Consideration is also being given to the scope and responsibilities of the MDM Coordinator role and how to ensure this role is sustainable for the future (there has been a very high turnover in recent years) given how essential they are to achieving a high quality, successful MDM.

15 The South Island Regional Radiation Oncology Partnership has commenced, incorporating the three cancer treatment centres. Initial work is focussing on tumour streams where variation is notable, with a view to developing recommendations for greater consistency in treatment. Breast radiation oncology is the first tumour stream to be considered.

Reducing inequalities

16-19 Te Waipounamu Māori Leadership Group has continued its active leadership and support of three projects focused on Māori health, two underway across the region to deliver sustainable change and more robust pathways for the Māori community and their whānau who have cancer. The projects are:1. A regional project across all DHBs initiated by GMs Māori, to understand and

improve the uptake of cervical screening across the Māori community, commenced in October 2016. The project has involved collaboration with key stakeholders across the South Island and will deliver recommendations to target health inequities in cervical screening coverage.

2. An FCT-funded project with a focus on providing coordinated and joined up services for Māori patients with cancer across the South Island.

3. A third South Island wide project being led out of NMDHB has a focus on educating service teams, through a Māori Health Educator approach.

20 The Upper South Psychosocial and Supportive Care service is anticipating being fully staffed by the end of the year. Volumes are increasing, and efforts to increase Māori participation in Nelson Marlborough are paying dividends. The Canterbury team is seeking to facilitate engagement with Māori and Pasifika patients via primary health care services. Referrals for patients on the West Coast continue to warrant regular visits, with some of the more remote patients requiring home visits.The Lower South service is still seeking a social worker for Invercargill. There is now adequate clinical space for the current volume of patients, although patient numbers are starting to increase. There has been a focus on increasing availability of support throughout the Southern DHB region.Risks to the initiative include a lack of suitable protection of confidentiality and privacy of sensitive information, and the lack of permanent contracts for team members at Canterbury DHB. These are both under active consideration.

Tumour standard reviews[from 16- 17 work plan]

The report on the review against the lung tumour standards has been signed off by the DHBs and is progressing through the sign-off process.The majority of missing data for the gynae audit has been obtained and the SCN is working with Canterbury DHB Planning and Funding on the revised analysis.

MONITORING / BUSINESS AS USUAL ACTIVITYTransition to BAU

Consideration is being given as to how best support the transition of key project activities to Business as Usual – these will be updated here as and when required.


CHALLENGESFaster Cancer Treatment

1 DHBs are implementing strategies to sustainably improve services to meet the Faster Cancer Treatment target.Lung cancer services continue to be challenged by the 62-day health target; the SCN will review these services across the region and look for any specific areas of concern.Over the last few quarters there has been a decreasing trend in the number of patients on the 31-day pathway in CDHB. With CDHB being the largest contributor to the number of patients across the South Island, this is reflected in the regional trend also. Additional efforts are currently underway within CDHB, with support from SCN, to identify the cause.

Reducing inequalities17 Improving the Cancer Pathway for Māori – regional rollout (Project B) is delayed as

feedback still to be received from SDHB regarding final report so necessary changes can be made and the Implementation Plan drafted. Further work has been undertaken during Q1 to ensure that DHB feedback has been appropriately captured and reflected. The project expected to be complete by the end of November 2017.



Growing Up Healthy

1Working cross-sectorally to better manage the safety of vulnerable children and reduce family whanau violence. Q4

2Support the SI DHBs to understand and respond to information reported from e-Prosafe Q4

3Work with maternity services to continue to reduce Sudden and Unexpected Death in Infants in the South Island with particular emphasis on Maori and Pacific populations.

Q1,2, 3,4

Young Persons Health

4In partnership with Health Promotion Agency, SI Public Health Partnership and SI Mental Health and Addictions SLA, implement recommendations of SI ED scoping exercise (subject to funding)

Q3

5Support DHBs to implement the Ministry of Health’s Sexual and Reproductive Health Action Plan as it relates to teen pregnancy. Q3

Access to Child Health Services

6aSupport interventions to reduce ambulatory sensitive hospitalisations for skin infections, eczema and dermatitis with an emphasis on at risk children and families, Maori and Pacific 0-5 years.

Q2,3

6bImprove Maori and Pacific engagement with WellChild Tamariki Ora providers to support reduction in ambulatory sensitive hospitalisation rates for skin infections, eczema and dermatitis.

Q2

7Support the South Island Diabetes Working Group to implement their workplan including understanding service delivery to Type 1 Diabetic consumers.

Q3

Regional obesity management programme

8 Develop and implement a childhood healthy weight programme Q4

9Align Childhood Healthy Weight Programme with MOH health target for child health Q4

10Work to reduce the number of dental ambulatory sensitive hospitalisations in 0-4 year olds. Q4

11 Sharing learnings from Healthy Families Christchurch and Invercargill. Q4

12Improve uptake and use of South Island Regional Electronic Growth chart. Q1

Consumer Consultation

13 Develop a SI child/youth/parent/caregiver survey Q3

KEY PROGRESS IN QUARTER 1Growing up Healthy

1

Actions from the workshop held February 2017 between the SI Violence Intervention Coordinators, SI Paediatric Radiologists and SI Paediatric Clinical Directors have been circulated. A consistent SI approach to violence intervention, training, implementation and policy development is required. The SI CH SLA are undertaking this work in partnership with Canterbury DHB Child and Family Safety Service coordinator.

3

Work continues to support SI DHBs to undertake the Safe Sleep audits and the subsequent reports. The SIA will host the SUDI Regional Coordinator role. Positioning the role in the SIPAO will enable more alignment and timely use of resources. It will also provide more opportunity to build on the SUDI work already undertaken by the South Island Safe Sleep Policy Audit Working Group a sub group of the SI CH SLA.

Access to Child Health Services7 A Model of Care (draft) has been reconfigured following consultation with

stakeholders. The staffing recommendations as they are developed will be considered within the context of the model of care and resourcing in all SI DHBs. Any staff resourcing need identified will be discussed with individual DHBs.

Regional Obesity Management Programme8 Feedback on the draft strategic and operational plans for Healthy Weight in Childhood

is being considered. Work is underway to evaluate the impact of community obesity interventions on pre-schoolers, including MEND, Active Families, Triple P Healthy Lifestyles and others. Evaluation markers for children one year following referral have been agreed and funding options to complete the work are being considered.

12 Users of the Southern DHB Anthropometrics (eGrowth Charts) solution is growing across the South Island. Feedback has been largely positive. Enhancements to improve the functionality of the tool are near completion. 44,000 records have been logged on eGrowth Charts since 30 June 2016. Information Services SLA to be consulted on how best to enable eGrowth Charts use in primary care.

CHALLENGESObesity Management – Triple P Healthy Lifestyles Group

8

There are some ongoing challenges around the development of this programme, including a lack of identified funding to pay Triple P HLG facilitators and Māori/Pacific concern the programme may not work for their communities. Further engagement with stakeholders is being undertake to resolve these issues. The lack of identified funding/resourcing for evaluation of the programme is also yet to be resolved.


CHILD HEALTH SLA

MENTAL HEALTH & ADDICTIONS SLA


Alcohol and other drug services

1aAdvice provided to the implementation of a South Island withdrawal management plan including the new Substance Addiction Legislation (SAL)

Q1,2,3,4

1b Support the identification of Māori and Pacific population concerns Q2,4

1c Workforce Development needs identified and supported Q2,4

Youth Forensic 2Youth Hub and Spoke model evaluation and reporting to determine effectiveness of plan.

Q2,4

Workforce

3aContinue the engagement started with the South Island Mental Health and Addiction Workforce Development plan in 2016/2017

Q1,2,3,4

3bContinue to maintain and strengthen the Education and Training group.

Q1,2,3,4

3cEstablish and support the South Island Mental Health and Addiction Workforce Planning Work group

Q1,2,3,4

People with high & complex needs

4aIntellectual disability and mental health: support development of workforce for patients with Intellectual Disability and mental health issues

Q4

4bForensic Services: A gap analysis of the barriers to the transition between inpatient forensic services to community based services

Q2,4

People with low prevalence disorders

5Develop a plan to support the physical health of people with low prevalence disorders

Q4

Adult forensic services

6Prison screening data provided (Prison screening occurs within agreed timeframes with 80% of prisoners referred seen within 7 days of receipt of referral)

Suicide prevention planning and actions

7aFormation of working group/expert panel to provide advice and strategic planning

Q1,2,3,4

7bMāori and Pacific concerns are addressed as part of the work of the expert panel

Q2,4

KEY PROGRESS IN QUARTER 1Alcohol and other drug services

1

The South Island AOD Model of Care has been developed. MHASLA have endorsed the Model. A regional advisory group of key stakeholders led by CDHB P&F has met twice and continues to work closely with MoH and Matua Raki on the requirements of the new legislation. Alfred Dell’Ario (CDHB) and Michael Haskew (NMDHB) will be Area Directors subject to MoH approval. Alfred may delegate to Carmen Lowe in Christchurch and the DAMHS office may be expanded. Applications are being accepted for Authorised Officers (AO). The next step will be to look at Authorised Specialists (AS).

Youth Forensic

2

A regional youth forensic day was held 14th August to report on the progress and success of the youth forensic model. The youth forensic pathway is being implemented across all South Island DHBs however it remains a live document. Smaller DHBs with limited forensic staffing can access the support of a bigger team which the hub offers. Using the pathway, smaller DHBs can get advice and discuss cases in order to offer a better service for the clients in their areas. A Christchurch Youth Forensic Team (YFT) planning session has allocated staff to be the key contact for each of the other DHB teams. Youth forensic teams in other DHBs now have an identified person as their first point of contact for advice and information.The Regional MDT monthly meeting has been established by VC to discuss cases with Consultant Psychiatrist, Psychologist, Pukenga Atawhai and another clinician from the Canterbury team.

Workforce

3

A comprehensive SI MHA Workforce Development Plan has been drafted which includes 50+ actions on developing new “whole of systems” regional strategies and activities to build capacity and capability in1. Leadership2. Cultural Fluency3. Models of Care4. Integration between Primary, Community/NGO and DHB/Specialist Workforces5. Inter-service and Across Service Collaboration6. Recruitment, Retention and Scope of Practice7. Education & Training8. Addiction Specific Workforce9. Family Safety and Wellbeing:The plan reflects the strategies that will need to be developed in line with the new national Health Workforce NZ plan. Workforce Development resource will be required to pursue this new work.This resource was previously provided by via Te Pou, the national workforce centre funded by HWNZ. This role was disestablished in June 2017. MHASLA have met with HWNZ to emphasise the need to resource the new plan. MHASLA have discussed this


need with Te Pou and the MHASLA Chair is writing to Te Pou outlining the issues. A copy will be sent to HWNZ highlighting this requirement.

People with high & complex needs

4

The current Mental Health/Intellectual Disability workforce has been reviewed and gaps identified. A report on the impact of the new MoH behaviour support arrangements on the South Island (Explore won the contract) has been completed and recommendations made to the behaviour support provider and the Ministry of Health. Further recommendations have been developed for DHBs, PHOs and NGOs.

People with low prevalence disorders

5

Equally Well is the approach MHASLA have agreed to take to supporting the physical health of people with low prevalence disorders. An Equally Well proposal has gone to MHA GMs for their input and feedback prior to progressing further. Discussions have also commenced with the Health Quality and Safety Commission Mental Health and Addiction Quality Improvement Initiative to ensure alignment with their six priority areas which includes maximising physical health of consumers with mental health and addiction problems (‘Equally Well’)

MONITORING / BUSINESS AS USUAL ACTIVITYAdult Forensic Services

6Prison screening data received. Figures will be relayed to MoH in accordance with the New Zealand Forensic Psychiatry Advisory Group schedule

CHALLENGESWorkforce

3

The new SI MHA Workforce Development Plan reflects the strategies that will need to be developed in line with the new national Health Workforce NZ plan. Workforce Development resource will be required to pursue this new work. This resource was previously provided by the Health Workforce NZ Regional Workforce Development Lead role provided via Te Pou, the national workforce centre. HWNZ has disestablished the role. MHASLA have met with HWNZ to emphasise the need to resource the new plan and MHASLA Chair has written to Te Pou and HWNZ highlighting this requirement.



Strengthening dementia pathways

1aEnsure people with dementia and their families and whānau are valued partners in an integrated health and social support system that supports wellbeing and have control over their circumstances

Q2,4

1bProvide DHBs with on-going support and overview so that DHBs identify and strengthen components of dementia care pathways within the parameters of the New Zealand Framework for Dementia Care

Q2,4

1cSupport interventions which seek to minimise disparities between Māori and non-Māori in relation to the timely assessment and diagnosis of dementia and subsequent care planning

Q2,4

1dSupport South Island DHB’s with the implementation of the South Island Dementia Model of Care

Q2,4

2Improve the quality and consistency of dementia education and support programmes in operation to support family/whanau carers (e.g., Living Well with Dementia) and people living with dementia.

Q2,4

3Continue to expand Walking in Another’s Shoes programme to foster Person Centred Dementia Care across the health continuum including different levels of staff and management

Q1,4

4

Promote the concept of ‘Think delirium’ across South Island DHBs with regard to delirium prevention.Encourage the development of delirium pathways in all South Island DHBs to assist in the prevention, assessment and management of delirium across the care continuum and create consistencies in care.

Q1,2,3,4

interRAI

5aPromote South Island health professions to use the information from comprehensive clinical assessment (interRAI) proactively in plan of care and in service planning/ development.

Q1,2,3,4

5bMonitor interRAI reports to identify trends including any trends or differences that may exist between Māori and non- MāoriAnalyse specific areas of the data from all South Islands DHBs

Q1,2,3,4

Advance Care Planning

6Support DHBs to develop ACP system implementation with processes to embed ACP as standard practice for those who will benefit

Q2,4

7ACP L1A and L 2 Training is available in a planned manner for staff in each DHB district in South Island (subject to resources)

Q1,2,3,4

8

Support South Island DHBs to participate and support National Conversations that Count Day (CtC). CtC education (Peer education for the public delivered ‘by the public’) is available in each South Island DHB (as resources are available)

Q1,3

Restorative Model of Care

9

Older people will be supported to set and achieve goals by a co-ordinated and responsive health and disability support service that also enables them to maintain their social connections with community life.

Q2,4

Workforce 10

Work with HWNZ and DHBSS to develop a sustainable mechanism for collecting a minimum workforce data set on the health workforce working in health of older people outside the DHB provider arm by 30 June 2018

Q4

KEY PROGRESS IN QUARTER 1Strengthening dementia pathways

1

The SI Dementia Model of Care is now finalised and ready to be circulated widely across all providers.The Model of Care was discussed with HOP Portfolio Managers from all SI DHBs on 6 Sept 2017 and priorities in the first two years were agreed:

a. Establishing dementia health navigation with an eye to health navigation in general

b. Ensuring all dementia services in each region are known / mapped outc. Carer support – urban / rural consistency. d. Supporting care partners of people with dementiae. Progressing meaningful support of primary care to engage with dementia

timely diagnosis, management, and possibly with other aspects of the whole framework journey

f. Progressing the needs of ‘special patient groups’, especially Maori but also other ethnic communities

There is a high level of support for this work regionally, as well as interest nationally.

4

Delirium stocktake report has been finalised and is ready to be shared around the SI. The stocktake findings support the need to improve delirium assessment, prevention and treatment around the South Island. Resources are available, but staff either do not know about them or cannot access them. Reports regarding incidence are not shared. The region will now develop a uniform report within each DHB regarding in hospital patients with delirium.


HEALTH OF OLDER PEOPLE SLA

Advance Care Planning

6

Electronic ACP format is finalised for the Health Connect South system. Work has now moved to finalising the print version of the electronic form. A SI ACP workshop was held 29 September 2017. The workshop focused on considerations to help each SI DHB with ACP change management plan and roll out plan. Feedback was positive.

MONITORING / BUSINESS AS USUAL ACTIVITYAdvance Care Planning

4b

Education is progressing according to the National ACP calendar.L2 – 2 courses planned for Q2 in SI (Christchurch and Dunedin)L1A – 1 Course held in Christchurch in Q1L1A courses planned for Q2 in Timaru, Nelson, Invercargill, Christchurch

CHALLENGESAdvance Care Planning

6

Feedback from clinicians indicates that 4 DHBs are under prepared for the role out of ACP system in their DHB.

There is no plan for ACP system implementation in 4 DHBs in order to support health care teams across the continuum to integrate ACP into current practice.



Information technology and services

1a

To inform and influence the development of information systems within the South Island that will deliver a more efficient and safer transfer of patient information between Palliative Care Providers (including Hospice services) across the SI while reducing costs and risk

Q4

1bFollowing the completion and evaluation of the current pilot, support the development and the roll out of Palliative Care interRAI across the South Island

Q3

Hospice and Hospital palliative care services

2a

Use the information from Hospital and Hospice Surveys and the evaluation of palliative care in primary care (PHOs ARC and P&F) to promote regional consistency and access to resources. Inform and influence South Island DHBs so services are aligned to the Resource and Capability Framework for Adult Palliative Care and the work of the National Adult Palliative Care Review

Q4

2bWorking within the National Paediatric Palliative care Guidelines: provide high level guidance within the South Island to those providing Paediatric palliative care

Q4

Primary and community care

3a

Based on the survey findings and best practice, develop and support the model of care that reflects the integration of specialist, secondary and primary care into a seamless palliative care service in the South Island.

Q4

3bPartner with St John to understand how palliative and end of life care is provided and how it can be improved

Q4

3cExplore and understand how Palliative Care is delivered by Maori organisations and other ethnic minority providers

Q3

3dExplore opportunities to provide guidance on the substantive competencies for allied health professionals undertaking education in palliative care in South Island.

Q3

Networking and engagement

4

Through benchmarking against the data collected through VOICES, which includes communication with Consumers and Maori on their experience of End of life; determine what and where improvements are called for and use this information to improve performance in the delivery of palliative care in the South Island

Q4

KEY PROGRESS IN QUARTER 1Information technology and services

1

Information on current Information Systems has been collected through the various surveys and have highlighted some inequalities in IS provision, for example access to shared electronic records, HealthPathways and online learning. Collective summary findings and recommendations to address this are being developed in Quarter 2.

Palliative Care Workstream continue to monitor uptake of e-prescribing in Hospices and sharing the learnings with information being provided by Marlborough and Otago Hospices.

Three HealthPathways being Developed for Palliative Care: Cancer Psychological and Social Support Service (CPSSS) –pathway for

wider dissemination Palliative Care Paediatrics – new pathway Te Ara Whakapiri – additional to existing pathway

Hospice and hospital palliative care services

2a

The Hospital Palliative Care Benchmarking Survey report and the Hospice survey report have been made available to SPaIT and ALT discussed and advice given. They will be reconsidered alongside the Primary Palliative Care survey reports which are currently being completed.

2b

Work has commenced on a South Island Paediatric Palliative Care HealthPathway (HPW). This HPW will capture the essence of Paediatric Palliative Care when using resources such as the Advanced Care Plan. It will link clinicians with current guidelines, Starship website and other national documents.

Primary and Community Care

3

The results from the Primary palliative care surveys from SI PHOs, planning and funding teams and SI ARC are being analysed and reports written. The aim of these surveys is to help us evaluate the current scope of palliative care provision in non-specialist areas.

Meetings have been held with the SI Workforce Development Hub to identify within Allied Health workforce key areas of work where PCW can add value, for example, professional support particularly in small DHBs. SI Directors of Allied Health have been approached to consider direction and SI alignment of current projects to best meet the PC requirements of workforce.

Networking and engagement4 The Views of Informal Carers’ Evaluation of Services (VOICES) work is underway. The

term of the contract is March 2017- March 2018.


PALLITATIVE CARE WORKSTREAM

CARDIAC SERVICES WORKSTREAM


South Island Model of Care

1aSouth Island Cardiac Model agreed and implemented consistently in the region (within resources available)

Q2,4

1bSI Alliance Leadership Team approves the recommendations of the model of care project group.

Q2

1cRecommendations adopted by the cardiac workstream and specific project groups established

Q2

1d Implementation of change evidenced by audit Q4

2Access to tests: all South Island DHBs recording and storing ECGs on common repository

Q2,4

3aOptimal HealthPathways: STEMI Pathway in conjunction with St John implemented

Q2

3bOptimal HealthPathways: Common Accelerated Chest Pain pathway implemented in South Island hospitals

Q2

3cOptimal HealthPathways: review and audit Acute Chest Pain Pathways in Emergency Departments

Q4

Equity of access 4

Monitor access rates for high risk population groups. Prepare reports at Q2 and Q4 from ANZACS QI data to show intervention rates for Maori, Pacific and Asian people to help identify and address any issues.

Q2,4

Meeting national indicators

5Support South Island DHBs to address any challenges that arise with providing appropriate cardiac care and meeting standardised intervention rates

Q1,2,3,4

6Support South Island DHBs in the continued achievement of national indicators around equity of access

Q1,2,3,4

Heart failure 7Implement locally, regionally and nationally agreed protocols, guidance, processes and systems to ensure optimal management of patients with heart failure (within available resources)

Q4

Workforce training

8Implement recommendations formed in conjunction with National Network (subject to resource constraints)

Q4

Transporting cardiac patients

9Guidelines for transporting cardiac patients agreed in 2013 and updated 2015/16 are consistent for the South Island

Q4

KEY PROGRESS IN QUARTER 1South Island Model of Care

1Sustainable South Island Cardiac Services Consensus Report was prepared and submitted to the Alliance Leadership Team (ALT) in October.

2Work on implementing the ECG repository is progressing. A good relationship has been developed with the supplier ahead of implementation in each DHB, starting with Canterbury and Nelson Marlborough.

3The Workstream is working alongside St John in agreeing the STEMI pathways. Other pathway development is dependent on the approval of the SI Cardiac model of care

Meeting national indicators

6

Detailed data from ANZACS QI has helped SDHB identify that not all areas in the district have been gaining equitable access to PCI. Steps have been taken to make improvements, and future ANZACS QI reports will indicate if these have been successful in ensuring equitable access irrespective of location. Having this type of data available enables the region to identify, address and monitor equity issues.

MONITORING / BUSINESS AS USUAL ACTIVITYMeeting national indicators

5/6ANZACS QI data, including regional graphs and MoH data from the Quickr site are used for monitoring and reporting access and intervention rates.

8The region maintains regular links with the National Network through the Alliance and contributes to national initiatives.

CHALLENGESSouth Island Model of Care

1

The work on developing and approving a South Island Cardiac Model of Care has taken much longer than anticipated. This has delayed progress on some of the cardiac matters which are dependent on implementing the recommendations of the model.


Cardiology and Cardiothoracic Procedures:Intervention rates per 10,000 to 30 June 2017. Posted on MoH Quickr site September 2017

Nelson Marlborough

West Coast Canterbury South Canterbury

Southern

Angiography

National Intervention Target Rate per 10,000

34.27 34.27 34.27 34.27 34.27

Standardised Intervention Rate per 10,000

33.85 28.57 36.89 28.27 38.79

Expected discharges 656 151 1802 268 1134

Actual discharges 648 126 1940 221 1306

Variance from National target

Not Significantly different

Significantly below

Significantly above

Significantly below

Significantly above

Angioplasty


12.89 12.89 12.89 12.89 12.89


11.21 12.72 14.09 9.33 14.44






Significantly above

Significantly below

Significantly above

Cardiac surgery


5.87 5.87 5.87 5.87 5.87


4.66 6.98 5.47 5.78 8.17




Significantly below


Significantly below


Significantly above

DHB ranked out of 20Region ranked out of 71 is highest ranking

Ranked for Angiography

Ranked for Angioplasty

Ranked for Cardiac Surgery

Nelson Marlborough 9 17 18

West Coast 16 8 4

Canterbury 6 5 13

South Canterbury 17 19 12

Southern 4 3 1

South Island excl NM 1 1 1

South Island incl NM 2 3 2



Improve equity of access to elective services

1aImprove equity of access, system quality and practice in selected elective service areas through the establishment of project, team and methodology

Q1,2,3,4

1b

Identify baseline for Māori access (current and evidence) in selected priority areas Including access to primary care, and referrals into services.When collecting health data, this will be recorded separately by Māori & non Māori

Q1,2,3,4

1cCollate and share innovations in the selected service areas via best practice documents and use of HealthPathways

Q1,2,3,4

2Support South Island DHB management of regional electives volumes including the longer term approach to electives across the South Island that maximises resources

Q1,2,3,4

Bariatric surgery 3Support management of South Island Bariatric Surgery Service by CDHB with the introduction of an independent Chair

Q4

Plastic Surgery 4Implement agreed process to access Plastic surgery for post bariatric patients

Q2,4

Vascular Services

5Implement the nationally agreed Vascular Services model of care in the South Island

Q2,4

Eye Health Services

6a Develop sustainable Model(s) of Eye Health Care for the South Island Q2

6b Complete model(s) of care and agree implementation process Q3

6cRecommend a transition pathway, including resource implications, to achieve the desired model(s).

Q4

Maxillofacial Services

7 Agree a sustainable South Island plan for Maxillofacial Services Q1,3

Otolaryngology 8 Agree a sustainable South Island plan for ENT Services Q1,3

Orthopaedic Services

9 Agree a sustainable South Island plan for Orthopaedic Services Q1,3

Colonoscopy / bowel screening

10Support South Island DHBs to meet Colonoscopy Waiting Times Indicators

Q2,4

11South Island planning to support Bowel Screening Regional Centre development and implementation and Tranche 2 & 3 rollout schedule

Q1,2,3,4

Urology 12 Consistent Urology follow-up and surveillance processes Q4

KEY PROGRESS IN QUARTER 1Improve equity of access to elective services

1 This work continues to be a significant focus across the region and is progressing well.

Plastic Surgery

4The focus has been on agreeing an Excess Skin Pathway, and readiness for its implementation. Service scope, volumes need to be agreed. A Plastics workstream will follow as this is a vulnerable service.

Vascular Services

5

The MOH has led the development of a national Vascular Services model and consultation process. In June 2017 the model was agreed by national GMs P&F. SI implementation will follow when MOH proceeds with regional model of care discussions and contracting

Bowel Screening

11Southern DHB has been endorsed by the South Island DHBs as the Bowel Screening Regional Centre, which will be in place by April 2018.

MONITORING / BUSINESS AS USUAL ACTIVITYBariatric Surgery

3

The Workstream continues to oversee the South Island Bariatric Surgery Service. The Service provided a benefit proposition for surgery based on the service’s annual report and review of post-surgery hospitalisations of 100 patient records. Other SI services may be developed drawing upon the success of the SI Bariatric Service.

Management of regional electives volumes

2The Workstream continues to support DHBs to maximise resources in delivering elective services.


ELECTIVE SERVICES WORKSTREAM


South Island Major Trauma Plan

1South Island Major Trauma regional plan is reviewed and updated: South Island region focuses on implementation of local and regional trauma systems

Q2,4

NZ Major Trauma Minimum Dataset

2a

South Island data collection and input into national major trauma registry no more than 30 days after patient discharge.Achievement of quality improvement markers as defined by the National Major Trauma Clinical Network

Q1,2,3,4

2bSouth Island ethnicity and rurality data by site is known including patient outcomes

Q1,2,3,4

Clinical leadership

3Responsibilities identified and assigned for Clinical lead and coordinator roles in each DHB

Q1

4 Trauma committees established in each DHB Q2

5Clinical leaders agree to and follow guidelines and inter-hospital transfer processes

Q1,2,3,4

Destination policies

6Implement Regional Destination Policies in collaboration with DHBs, Ambulance and Air Transport providers

Q2

KEY PROGRESS IN QUARTER 1South Island Major Trauma Plan

1

The plan was approved at the Workstream’s June meeting. The Workstream plans are being followed to comply with local and regional processes. Strong links are maintained with the National Network.

Ethnicity and rurality data

2bData is now available from the national dataset. The Workstream is preparing a set of common data fields to capture further information on admitted trauma patients.

Transfer of patients

5/6Work is underway with clinical leaders and in conjunction with St John to agree to and follow inter-hospital transfer policies and develop a regional destination policy.

MONITORING / BUSINESS AS USUAL ACTIVITYNZ Major Trauma Minimum Dataset

2The SI is contributing information to the national minimum dataset under the national agreement.

3Trauma Nurse Coordinators in each district are taking up training opportunities and are drawing on the training fund (from the ACC incentive funding) for this purpose.

CHALLENGESNZ Major Trauma Minimum Dataset

2

It remains a challenge that inadequate resources are allocated to trauma data collection and to developing a major trauma service in most South Island hospitals. Data gathered to date is providing a greater picture and helping form a case for appropriate resources.


MAJOR TRAUMA WORKSTREAM


Collective Impact

1 Governance: Establishing an engaged cross-sector Public Health SLA Q4

2 Governance: South Island Public Health Strategic Framework developed and agreed Q4

3 Population health reporting: Initial South Island Population Health Report complete Q4

4 PHU infrastructure: Enhanced leadership alignment of the South Island Public Health Partnership/three Public Health Units

Q1,2,3,4

5 PHU infrastructure: strengthened operational alignment of the South Island Public Health Partnership/three Public Health Units

Q1,2,3,4

6 Evaluation: Evaluation of the South Island Public Health Partnership’s evolution and the SLA’s development

Q1,2,3,4

7 Communications: Positive profile and support of the PH SLAs work Q1,2,3,4

Māori

8 Promotion of key messages on South Island priority public health issues as they pertain to Māori by Te Herenga Hauora

Q1,2,3,4

9 Selection of a priority public health issue for Māori for a collaborative approach Q1

Environmental sustainability

10Comprehensive current data to inform next steps, including gap analysis and identification of potential useful and cost-saving measures for DHBs to consider

Q3

11

Promote awareness of the policy/position statement once South Island DHB Boards endorse. Utilise DHB Boards endorsement of sustainability to promote awareness and action in DHBs.

Q3,4

Health in all Policies

12

Promote awareness of the position statements once the South Island District Health Boards have endorsed them:

Water fluoridation Air Quality Warm Homes Sugar sweetened beverages Environmental Sustainability

Q2,3,4

13 Undertake new regional approaches/ initiatives to promote healthy eating and active lifestyles as identified in 20116/17.

Q1,2,3,4

14Identify and undertake regional approaches/initiatives re alcohol harm reduction, including contributing a regional population health perspective to the Alcohol Harm Reduction ED Project.

Q1,2,3,4

Rheumatic Fever 15Ongoing monitoring and collective South Island public health response to results

Q1,2,3,4

KEY PROGRESS IN QUARTER 1Establishing an engaged cross-sector Public Health SLA

1

The third co-design workshop was held on 25 August with positive engagement from cross-sector participants. Participants external to the SI Public Health Partnership included key people from the from Te Putahitanga o Te Waipounamu – the Whanau Ora Commissioning Agency, the Ministry of Social Development, the Non-Government sector, Primary Health Organisations, the Ministry of Education and the University of Otago. (Territorial Local Authorities were not included as the local government participant was ill).

Key areas of progress included: gaining clarity regarding the macro and micro elements of the work; further developing the conceptual structure diagram and identifying the common agenda.

Strengthened operational alignment5 Discussions have been held across the three PHUs regarding the sustainability of

on-call and after hours health protection services. A project is being established to consider the sustainability of current on-call systems in PHUs, identify gaps and opportunities for development and produce a report, with an implementation plan to optimise systems.

Health in all Policies8 A presentation of the HiAP approach was made to the Child Health SLA and Healthy

Weight in Childhood Clinical Advisory Group by Dr Anna Stevenson on behalf of the SI PHP on 3 August. This was well received.

CHALLENGESHealth in all Policies

10/11Failure to appreciate environmental sustainability as a public health issue and associated lack of support. Completed stocktakes have not been received from all SI DHBs.

14Lack of dedicated alcohol harm reduction coordinators and the need for wide DHB engagement may adversely impact on DHB development of alcohol harm reduction strategies and the ability to deliver on the alcohol position statements.


PUBLIC HEALTH PARTNERSHIP


Organisation of Stroke services

1a

People with stroke admitted to hospital are treated in a stroke unit and/or in the setting of an organised stroke service (see PP20 for definitions of a stroke unit and organised stroke services).Support interventions which seek to minimise disparities between Maori and non-Maori

Q1,2,3,4

1bEnsure that existing acute stroke pathway information that is available to primary care is consistent across the South Island.

Q4

Thrombolysis

2aAll people with stroke have access to a quality assured thrombolysis service (24/7)

Q1,2,3,4

2bSouth Island regional centres collaborate with local ambulance services to ensure pre-notification to hospital services

Q2,4

2cA telestroke service for SI DHBs will be scoped for embedding in the South Island within available resources

Q2,4

Regional inter-arterial clot retrieval service

3A regional Intra-arterial clot retrieval service based in CDHB to be scoped for the South Island

Q2,4

Rehabilitation and community stroke services

4a

All eligible people with stroke receive early active rehabilitation services and equitable access to community stroke services (as defined by the National Stroke Network), supported by an interdisciplinary stroke team

Q1,2,3,4

4b

Work collaboratively with Stroke Foundation and Ministry of Health in order to Integrate Primary care at every opportunity including:

– Education– identifying prevention

Review Workstream membership and include primary care professionals

Q1,2,3,4

Workforce

5aDevelop a regional workforce plan that supports the delivery and achievement of high quality stroke care provision

Q2,4

5bCDHB and SIAPO will provide standardised thrombolysis education across the South Island regional centres via videoconference using a hub and spoke model

Q2,4

5cAll members of the interdisciplinary stroke team participate in ongoing education, training (a minimum of 8 hours stroke specific education per year (minimum standard) and service improvement programmes.

Q2,4

Information technology and analysis

6aIdentify actions that the region will take to support improved information management

6bIdentify trends in delivery of acute stroke services, thrombolysis, and rehabilitation services to detect disparity between Maori and non-Maori to inform improved service delivery

KEY PROGRESS IN QUARTER 1Thrombolysis

2

Work continues to scope a South Island telestroke service. A paper is being prepared for consideration for the 2018-19 South Island budget process.

The Stroke Ambulance Destination Policy has been finalised by National Stroke Network and circulated for use from 11 September 2017. Service consistency and coverage in smaller centres will continue to be worked on. Discussion and work around implementation of destination policies for telestroke / thrombolysis will inform the next stage of work for the inter-arterial clot retrieval service to be discussed at the November workshop.

Regional inter-arterial clot retrieval service

3

A briefing paper to endorse a South Island approach to achieve an Intra-arterial Clot Retrieval service was tabled for Leaders and Clinicians. This has led to a SI workshop day to finalise scoping of a regional Intra-arterial Clot Retrieval service. The workshop will be held 21 November with Anna Ranta attending to provide additional expert advice.

MONITORING / BUSINESS AS USUAL ACTIVITYOrganised stroke services

1

The SI Stroke measures reveal the minimum standard is not being achieved in all SI DHBs. Three centres are achieving. See tables on following page for further information.There has been in-depth analysis of Invercargill stroke service by MOH. Local team being supported by Stroke workstream in developing a plan to address weaknesses.

4

In Q4, three DHBs are 0% with the proportion of those referred to community rehab who are seen face to face within 7 days of inpatient discharge – this is due to their community service not meeting the minimum standard. See tables on the following page for further information.

CHALLENGESThrombolysis

2

There is variation of access to thrombolysis service across the SI. A regional telestroke service will improve consistency. A scoping for this service to inform the 2018-19 SI budget process is being completed.


STROKE SERVICES WORKSTREAM

South Island Stroke National Service Measures Q4 2016-17

80% of all stroke patients to be cared for in organised stroke unit DHB Hospital Numerator Denominator (all

stokes – bleeds, clots & unspecified)

Percent cared for in organised stroke service

SDHB Dunedin 0 13 61 0Invercargill 0 5 50 0Dunstan 0 2 11 0Oamaru 0 0 8 0

CDHB Christchurch 195 27 210 82Ashburton 0 2 5 0

WCDHB Grey Base 11 1 11 92NMDHB Nelson 0 6 27 0

Blenheim 0 0 16 0SCDHB Timaru 28 6 23 97

8 % of acute ischaemic stroke patients thrombolysedDHB Hospital Numerator Denominator

(excludes bleeds)

Percentage thrombolysed

SDHB Dunedin 2 61 3%Invercargill 0 50 0%Dunstan 0 11 0%Oamaru 0 8 0%

CDHB Christchurch Data not yet received 210 0%

Ashburton 0 5 0%WCDHB Grey Base 0 11 0%NMDHB Nelson 4 27 15%

Blenheim 0 16 0%SCDHB Timaru 1 23 4%

Proportion of those referred to community rehab who are seen face to face within 7 days of inpatient discharge. National measure - target 80%DHB Hospital Numerator Denominator Percentage seen

within 7 days

SDHB Dunedin 0 0 0%Invercargill 0 0 0%Dunstan 0 0 0%Oamaru 0 0 0%

CDHB Christchurch 6 93 6%Ashburton 0 0 0%

WCDHB Grey Base 2 5 0%

NMDHB Nelson 0 0%Blenheim 0 0%

SCDHB Timaru 7 12 58%



Serious and adverse events

1 DHBs understand the National Reportable Events policy Q3

2Regional agreement on application of the new reportable events policy

Q4

3 Build regional capability in investigators of SAEs Q4

HQSC Projects4 Regional approach to HQSC Deteriorating Patient programme agreed Q4

5 Collaboration on HQSC Pressure Injury Prevention Programme Q4

Regional policies 6 Identify policies that could be regional policies Q4

Safety 1st

7a Regional South Island DHB Safety 1st reports Q4

7b Support ongoing development and review of Safety 1st Q4

7c Support the Safety 1st Control Group Q4

Tikanga 8 A stocktake of Tikanga in the South Island DHBs Q4

Regional quality improvement

9Explore regional approached to share learnings of improving quality of care

Q4

KEY PROGRESS IN QUARTER 1Serious Adverse Events

2

Each DHB has procedures and templates in place already. HQSC has not yet offered national templates for the new national policy but are working on non-specific examples.Appropriateness of any development of regional templates was discussed by the Quality Managers at Patient Safety Group on 18 Sept. The group agreed to approach this work by focussing on specific areas. These are• SAC rating• Chart changes• Risk register• Near miss/actual event• Methodology for SAE review• Always-report-and-review reinforcementA review of the templates in use is underway, to be shared after HQSC training has been delivered and local training on DHB SAE processes has been completed.

3 NMDHB have four Quality Improvement Advisors who have completed the HQSC

QI training, three of whom sit on ELT, one a senior manager. Two more are undertaking training at present- both work in Clinical Governance. A further two about to start, one in strategy and one a pharmacist.

SCDHB have two Quality Improvement Advisors who work as part of the Quality and Risk Department Team. The team members each hold a specialist portfolio of quality leadership through which they support the DHB to plan for quality initiatives, facilitate committees established to address identified areas of priorities, facilitate investigations into SAEs including documenting learnings and supporting sharing these across the DHB.

CDHB are moving to a centralised model of Patient Safety Officers where coordinators pull panels together and write up reports which are sent to clinical governance groups for review. Services do not encounter serious adverse events frequently enough to retain expertise in handling the process so there is benefit in dedicated investigator roles reporting to service experts on panels. CDHB have instituted panels for Falls Prevention and Pressure Injuries.

Similarly, SCDHB find SMOs are happy to sit on panels where quality improvement staff facilitate the process, sometimes calling in expertise from primary care and maternity when necessary.

HQSC Deteriorating Patient Programme

4

NMDHB is the pilot site for the early warning score part of this project. NMDHB Quality team have now picked up the project in a wider context and there will be some adaptations. CDHB are implementing the programme and switched over to the NZ Early Warning Scores on 19 Sept. CDHB have also suggested Dunedin as the next HQSC meeting on the programme. SDHB have worked on this project previously and continue to look at documentation and responses.

HQSC Pressure Injury Prevention Programme

5

HQSC are working on process and outcome measures with three pilot sites, including Southern DHB. Most SI DHBs are adopting and implementing this project. SDHB have enjoyed the benefit of starting from scratch on the project, tying the work back into SAC coding and Safety1st. The SDHB work is going well and HQSC are writing up a SDHB shared learning story for their website. SDHB continue to keep the region informed of the progress of the project by providing updates at the Quality and Safety SLA meetings and the South Island Patient Safety Group meetings.

NMDHB are looking to identify a lead. SDHB are working on measurement work and have requested ACC funding to continue this work.

Regional Policies6 National direction is required to identify which other regional policies will be pursued.

It has been agreed the focus of regional policies will be new policy areas and Quality


QUALITY & SAFETY SLA

Managers will determine which policy areas would be amenable and work on these as they emerge.

Safety 1st

7A temporary Project Manager has been appointed to Safety1st and is producing a report and business case for regional supports.

MONITORING / BUSINESS AS USUAL ACTIVITYRegional Quality improvement

9The Quality Managers meet as the Patient Safety Group every two weeks to share learnings of improving quality of care. Members of the HQSSLA also attend the annual workshop with the Health Quality and Safety Commission.



Strategic Plan 1Complete review and refresh of the South Island Information Services Strategic Plan Q2

eMedicines Programme

2ePrescribing and Administration (ePA): West Coast DHB ePrescribing and Administration project complete Q4

3ePrescribing and Administration (ePA): Nelson Marlborough DHB ePrescribing and Administration project complete for Wairau campus

Q4

4ePharmacy Management (ePM): Implementation of ePharmacy completed across DHBs Q4

eReferrals Programme

5 Stage 3: Complete South Canterbury DHB eTriage implementation Q3

6 Stage 3: Complete Southern DHB eTriage implementation Q3

7Stage 3: Complete Nelson Marlborough DHB eTriage implementation Q3

South Island Patient Information Care System (SIPICS)

8Canterbury DHB: Complete the progressive implementation of SI PICS into other Canterbury DHB sites Q4

9Nelson Marlborough DHB: Project go-live for Nelson Marlborough DHB Q3

10South Canterbury DHB: Prepare for SI PICS implementation including the development of the implementation business case and initiation of project planning

Q4

11West Coast DHB: Prepare for SI PICS implementation including the development of the implementation business case and initiation of project planning

Q4

12Southern DHB: Commence development of the implementation business case for SI PICS Q4

ED information solution

13 Identify the preferred South Island solution Q2

14 Progress business case/implementation planning Q4

Regional Service Provider Index



17 Commence a phased roll-out Q4

eOrdering of Radiology tests


19Implementation of eOrdering Radiology tests completed for Nelson Marlborough, South Canterbury, West Coast DHBs Q4

20 Confirm integration requirements of Southern DHB RIS platform Q4

into Regional éClair Clinical data repository

Mental health

21Identify and confirm the preferred South Island approach for delivering the required mental health functionality Q4


23Support SCDHB, WCDHB, NMDHB and SDHB to progress a paper-lite strategy for transitioning paper mental health records into the electronic health record

Q4

Alerts and warnings



Clinical workflow 26Scope, agree and commence the implementation of the processes and structures to enable the SI DHBs to create, configure and manage automated clinical workflow

Q4

KEY PROGRESS IN QUARTER 1HealthOne

With the launch of HealthOne in Nelson Marlborough on 1 August 2017, all five South Island DHBs are now sharing relevant patient information electronically. General practice teams can view a person’s test results and discharge summaries, and hospital physicians can access information about allergies, long-term conditions and current medications. This is particularly important if people are unable to speak for themselves, says Dr Bev Nicolls, General Practitioner and Clinical Director of Information Systems for Nelson Marlborough DHB. “Because all five DHBs are using the same system, it also means patient information is available anywhere in the South Island, regardless of DHB boundaries. “As a GP, I spend a lot of time chasing results and playing phone tag with other doctors, but now I have a person’s key health information at my fingertips.” says Dr Nicolls. “People won’t have to answer the same questions again and again, there will be less duplication of testing and I can spend more one-on-one time with my patients.” HealthOne provides a portal to patient information such as general practice and hospital records, allergies, prescribed and dispensed medications, and test results, providing a comprehensive picture of an individual’s health history. It is accessed by health professionals around the South Island more than 3,000 times each day. HealthOne has been rolled out across the South Island through the South Island Alliance. “This achievement is testament to the commitment of the five South Island DHBs to collaborate through the South Island Alliance,” says Nigel Millar, Chief Medical Officer, Southern DHB, and South Island Information Services Service Level Alliance member.

Strategic Plan1 The IS SLA and SI PHOs held an engagement workshop in September 2017. IS SLA and

the SI PHOs are committed to supporting the development of a shared vision and


INFORMATION SERVICES SLA

principles to foster an integrated primary and secondary care system from an IS perspective and reduce system complexity. Next steps involve the drafting a revised South Island Strategy for consultation.

eMedicines

2/3/4

The IS SLA is sponsoring a workshop, in late 2017, to review the status of the eMedicines programme across the SI. The workshop will take a whole of systems approach to reviewing progress to date, identifying and prioritising gaps within existing environment, next steps and formalising governance arrangements to oversee the electronic medications programme.

eReferrals

Stage 2: Successful roll-out to the identified ten departments in Nelson Marlborough has been completed. Due to the success of the rollout NMH will progress the roll-out to additional departments as a precursor to Stage 3. Due to complexities with aligning workflow across the SDHB sites it has been decided that SDHB will close Stage 2 and concentrate on resolving the workflow complexities for Stage 3. Stage 3: CDHB roll-out continues with four departments completed. CDHB rollout progress has slowed. CDHB have provided a project management resource to progress the rollout. The WCDHB implementation has commenced with three departments completed.

South Island Patient Information Care System (SI PICS)

8

Burwood Inpatients: The implementation into the surgical wards at the Burwood facility has now been completed. This has been a successful deployment, with an expected number of post go live issues that are being worked through by the programme. This is a significant achievement by all parties and marks the completion of the first major programme milestone, the implementation of SI PICS across the Burwood facility. Development: The next software release has been successfully delivered on time, with the full expected scope on 1 August 2017. This marks significantly improved delivery performance, and is the trigger for the ramping up of the NMDHB implementation team.

Regional Service Provider Index (RSPI)15 The South Island has commenced diligence for a South Island Regional Service

Provider Index with IBM and MKM/Nextgate and has undertaken a detailed review

with the MoH to better understand the suitability of the standard or advance IBM software available through the national HPI. MoH to provide a detailed option analysis on the suitability of the IBM standard vs advanced software to meet the South Island requirements. This will inform the option analysis for the full business case.Recruitment is underway to secure project resources (Project Manager, Business Analysis) for 6 months to complete due diligence and prepare the detailed Business Case.

MONITORING / BUSINESS AS USUAL ACTIVITYHealth Connect South – South Island Alliance strategic partnership with Orion Health

HCS Reliability Independent review into improving the reliability of the HCS production environment is underway. Clinical input will form part of the requirements of the review. South Island to review and where appropriate revise existing HCS KPIs including measures and definitions.

CHALLENGESSouth Island Patient Information Care System (SI PICS)

10 -12

Discussion to occur between the three remaining DHBs – South Canterbury, West Coast and Southern – regarding sequencing of SI PICS implementation. The SI PICS Regional Steering Group have asked to bring these discussions forward into 2017 to allow appropriate time for DHB planning and business case development as required.

eMedicinesThere are a number of challenges with the existing plan, including the inability to have a single instance of Medchart across the DHBs and the impact that this has on the ability to deliver a single instance of ePharmacy.

The South Island is working actively with DXC, the vendor for the ePharmacy solution, to identify a transition plan from the current Windose application to ePharmacy with transition plan to incorporate an extension to the current support model for those DHBs on the Windose application. Discussions being progressed on whether there is a need for the South Island to make a tactical implementation of two ePharmacy environments to support the current two instances of Medchart.



Workforce planning

1Health workforce data and intelligence is collected to support planning

Q1,2,3,4

2The pipeline for health workforce is aligned with health workforce need

Q1,2,3,4

3Kaiāwhina workforce: Allied Health Assistants (AHAs) working across the South Island health system have access to appropriate NZQA level 3 training

Q1,2,3,4

4Kaiāwhina workforce: the Careerforce NZQA Level 4 Health and Wellbeing qualification is included in the AHA development framework

Q4

5Kaiāwhina workforce: Allied Health Assistants (AHAs): An effective delegation model is in place for services where Calderdale Framework (CF) has been implemented

Q4

6An effective skill sharing model is in place for services where Calderdale Framework has been implemented Q4

7Ensure sustainability of workforce redesign model (CF)across South Island Q4

8Inter-disciplinary: A coordinated clinical simulation network for the South Island is established Q4

9Inter-disciplinary: South Island teams participate in the Health Care Challenge Q2

10Allied Health Scientific & Technical: regional clinical/professional leadership frameworks are implemented for smaller Allied Health & Scientific & Technical professions

Q4

11Medicine - new graduates: community based attachments (CBAs)are in place to meet requirements of new Medical Council curriculum

Q3

12Medicine - new graduates: support the DHBs to integrate the increased number of PGY1s (NZ citizens and permanent residents) into the workforce

Q2

13Nursing - new graduates: support the employment & orientation of new graduate nurses Q4

14 Midwifery: clinical leadership is further developed Q4

Priority (vulnerable) workforces

15Sonography: support for the training of Sonographers to meet the identified South Island need Q4

16Rural Health Medicine: the opportunity of a South Island rural health medicine clinical placement programme is explored to support vocational training

Q4

17 Imaging workforce is fit for purpose Q4

Workforce diversity

18 Improved employee ethnicity data collected by South Island DHBs Q4

19Increased Māori DHB clinical workforce, working towards reflecting the South Island population Q4

20Establish a framework for Cultural Competence Education which ensures it is embedded into practice for the non-Māori workforce. Q4

Workforce enablers

21Lippincott Clinical Procedures: the South Island and Midland Regions are working in partnership to develop designing a national framework for the management of Lippincott New Zealand instance

Q4

22Elearning platform: work with Ko Awatea to establish a single platform for NZ

Q2,3,4

23Elearning packages: an increased number of eLearning packages are available to the South Island health workforce which can be shared nationally

Q1,2

KEY PROGRESS IN QUARTER 1Māori Workforce

19/20 Pilot of Takarangi (cultural) Competency Framework has commenced on the West Coast.

Nurse Prescribing

NewA South Island regional approach to nurse prescribing has been agreed, this is a new piece of work. A workplan has been developed which includes the development of a policy and framework for implementation across the sector.

eLearning

22The National GMs HR in conjunction with Ko Awatea and the South Island are sponsoring a national workshop on 20 November 2017 which will explore the current and future vision of eLearning.

Interdisciplinary

7/8The interprofessional community of practice recently hosted Margot Brewer from Curtin University (via VC). She discussed her research around interdisciplinary learning in clinical settings.

CHALLENGESOngoing funding The current contract expires in December 2017 The South Island Alliance has

allocated contingency funding through to June 2018. The HWNZ Group Manager has consulted the Hubs on the schedule for a new 3 year contract.


SOUTH ISLAND WORKFORCE DEVELOPMENT HUB

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